Introduction The advent of capsule endoscopy (CE) has presented new opportunities to assess and manage small bowel (SB) conditions. In obscure GI bleeding (OGIB) CE is the preferred method to examine the SB, with proven safety and efficacy. In Crohn's disease (CD) its role has been harder to establish in part due to fear of capsule retention. The British Society of Gastroenterology (BSG) guidelines propose radiological studies of the SB in the first instance, reserving CE for those in whom strictures have been excluded and findings are equivocal. However a recent meta-analysis highlighted superior diagnostic yield for CE compared with standard radiological imaging techniques,1 and SB studies are known to lack specificity in terms of excluding strictures.2 Although safety concerns are limiting the use of CE in this field, there is little evidence comparing CE complications in CD with those in established uses of CE such as investigation of OGIB.
Methods Individuals with suspected/established CD, or OGIB who had undergone CE following a standard prep regime (1 picolax±10 mg metoclopramide), were identified from a dedicated CE database established in 2006. Suspected CD was defined by the criteria in the BSG guidelines, OGIB by evidence of melaena, haematochezia, or drop in haemoglobin >2 g/dl and positive faecal occult blood test. A retrospective study design was employed. Key demographics were recorded. Studies were considered complete if the capsule was seen to pass into the caecum. Complications were recorded. Rates of completion and complication were compared between the two groups.
Results 102 patients were identified. 53 (52%) had suspected/established CD, mean age 39±15 years. 16 (30%) had established CD, and in six of these CE was performed to establish recurrence post resection. 49 (48%) underwent CE for OGIB, mean age 59±13 years. Complete visualisation of the SB was achieved in 94% (50/53) of the CD group and 93% (46/49) of the OGIB group (no statistical difference). Of note completion rates were significantly lower in suspected compared to established CD; 92% (34/37) vs 100% (16/16), (p<0.04). No cases of capsule retention (as defined by ICCE guidelines) occurred in the study cohort. Five patency capsules were performed in patients with suspected/established CD and obstructive symptoms, all subsequently had a complete CE. No adverse events occurred in any patient.
Conclusion CE is safe in both suspected and established CD with completion rates comparable to that in OGIB. Concerns regarding risk of retention may have been overestimated. Its use in regular clinical practice is likely to increase.
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